title: How long can patients with renal cell carcinoma wait for surgery without compromising pathological outcomes?
abstract: BACKGROUND
  Surgical wait times have been shown to be of significance in other malignancies, but limited studies exist in renal cell cancer (RCC). We analyzed surgical waiting time for RCC patients to see if there was an adverse impact on pathological characteristics.
  
  
  METHODS
  Our centre triages RCC patients on the basis of perceived tumour risk. The waiting time for surgery is adjusted stage for stage: clinical T1 at 90 days, T2 at 40 days, T3 and T4 at 30 days. We retrospectively reviewed the charts of 354 patients who underwent surgery for RCC. Patients were assessed for pathological upstaging, positive lymph nodes, tumour recurrence and tumour size within each stage. Analysis was performed, using surgical waiting time as a categorical variable, to test for associations with disease recurrence or adverse pathological characteristics.
  
  
  RESULTS
  The median time from the first consultation to surgery was 41 days and the mean follow-up was 26.6 months. Waiting time stage for stage was: clinical T1 at 57.12 days, clinical T2 at 36.8 days, clinical T3 and T4 at 30.32 days. On multivariate analysis, pathological tumour size was associated with progression, whereas no significant association was found between waiting time and upstaging. Higher stage tumours, sarcomatoid pathology and clinical evidence of progression were associated with shorter waiting times for early interventions.
  
  
  CONCLUSIONS
  There was no statistically significant evidence for upstaging or progression during the waiting period for our group of patients. The data reinforce previous studies reporting a "safe" period of active surveillance in T1 RCC without affecting their final pathological outcome.
authors.affiliation: Division of Urology, Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON; Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON;
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Martínez
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Venu
authors.initials: V
authors.lastname: Chalasani
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Williams
authors.forename: Patrick P W
authors.initials: PP
authors.lastname: Luke
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Izawa
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Chin
authors.forename: Larry
authors.initials: L
authors.lastname: Stitt
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Pautler